So we may better understand your requirements and meet your needs,
please provide us with the information requested below.

Please be sure to complete all information in yellow to
ensure proper and timely delivery. We need this
information in order to respond to your request.

Company
Requested By Name & Title
Address
City
State	Choose a State Outside U.S./Canada: Fill in below AL Alabama AK Alaska AB Alberta AS American Samoa AZ Arizona AR Arkansas BC British Columbia CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FM Micronesia FL Florida GA Georgia GU Guam HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MB Manitoba MH Marshall Islands MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NB New Brunswick NF Newfoundland NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota MP Northern Marianas NT Northwest Territories NS Nova Scotia OH Ohio OK Oklahoma ON Ontario OR Oregon PW Palau PA Pennsylvania PE Prince Edward Island PR Puerto Rico QC Quebec RI Rhode Island SK Saskatachewan SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VI Virgin Islands VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming YT Yukon
Zip Code
Country
Phone #
Fax #
Email Address
Proposed Location of the Equipment (address) :
Inlet Gas
Volume Specify Measure NM3/hr pph acfm scfmD Specify Volume Minimum Normal Maximum
Pressure Specify Measure psla pslg inches H2O mm Hg
Allowable Pressure Drop Specify Measure inches H2O mm Hg
Temperature
(dry bulb) °C °F (wet bulb) °C °F Relative Humidity %
Source of Fume
Existing New
Reason for Removing Contaminant
Particle
Quantity lbs/hr
Inlet Loading Specify Measure grains Mg NM3 ft3
Outlet Loading Specify Measure grains Mg NM3 ft3
Density lbs/ft3
Particle Size Distribution
Size Range
% by weight or % by count
% by removal required